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Diabetes is the most common endocrine disorder, affecting 8.3% of the population (1). Skin disorders will be present in 79.2% of people with diabetes (2). A study of 750 patients with diabetes found that the most common skin manifestations were cutaneous infections (47.5%), xerosis (26.4%), and inflammatory skin diseases (20.7%) (2). Individuals with type 2 diabetes are more likely than those with type 1 diabetes to develop cutaneous manifestations. Cutaneous disease can appear as the first sign of diabetes or may develop at any time in the course of the disease. This review provides a brief overview of skin conditions that primary care providers(PCPs) may encounter when treating patients with diabetes.
Conditions Associated with Insulin Resistance
Acanthosis Nigricans
Acanthosis nigricans (AN) is likely the most readily recognized skin manifestation of diabetes (3). It is present in up to 74% of obese adult patients and can be predictive of the existence of hyperinsulinemia (4). The presence of AN is a prognostic indicator for developing type 2 diabetes.There is also a possible genetic predisposition or increased sensitivity of the skin to hyperinsulinemia in different ethnic groups. At the same obesity rates, prevalence of AN is lowest in whites (0.5%), higher in Hispanics (5%), and even higher in African Americans AN is a hyperpigmented velvety thickening of skin folds, presenting predominantly in the neck, axilla, and groin areas (Figure).
Figure. Acanthosis nigricans and acrochordans
Possible additional presentations could include skin tags and hyperkeratosis. Heredity, obesity, endocrine disorders, certain drugs, and malignancy are associated with AN. Benign AN type 2 is related to type 2 diabetes and pseudo-AN type 3 is associated with the metabolic syndrome. Type 2 diabetes–related AN has an insidious onset and initially presents as hyperpigmentation. Both underlying conditions present with insulin resistance (3). Children aged 8–14 years who had AN were found to have insulin resistance, and 25% had disturbed glucose metabolism at the time of the study (6). Microscopically, AN presents as papillomatosis and hyperkeratosis (epidermis in irregular folds, exhibiting various degrees of acanthosis).
Treatment consists of treating the underlying cause. Significant weight loss resolves AN type 2 and type 3. Topical or systemic retinoids and topical retinolytics may be used to manage symptoms.
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Source: GP Clinics Vol 7 No 9, December 2016
